Provider Demographics
NPI:1699955997
Name:KALLOS, EXPEDITO BALDEO JR (PT)
Entity type:Individual
Prefix:MR
First Name:EXPEDITO
Middle Name:BALDEO
Last Name:KALLOS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3823
Mailing Address - Country:US
Mailing Address - Phone:352-238-4039
Mailing Address - Fax:
Practice Address - Street 1:6151 PIEDMONT DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-3823
Practice Address - Country:US
Practice Address - Phone:352-238-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist